I must also confess that many Ayurvedic and Unani Physicians are more convincing and appealing to diabetics than myself or my colleagues are. All goes well till these diabetics invariably get into some serious problems of heart, brain, kidney, eyes or legs. And, by that time it is always too late to do anything about diabetes except for undertaking very expensive and sophisticated therapies like coronary bypass surgery, kidney transplantation, laser photocoagulation into the eyes, or limb amputations and skin grafts, which are also not commonly available at all places. Such are the maladies of unscrupulous alternate medicines, as a diabetologist I am faced with in a referral hospital.

The impetus for writing this essay is mostly due to the confusion created by a T.V. news program by a senior teacher of Clinical Pharmacology of our state advocating daily consumption of sweet lime juice as a remedy for diabetes. To my much surprise, the impact of this prime time announcement was beyond our expectations. Many diabetics all over the state have started taking sweet lime juice every day in the morning hoping to cure diabetes. Though this is not anyway harmful to a diabetic, it certainly alters the therapeutic regime one might be advised to follow. After an extensive literature search and discussions with my teachers of diabetology, I am to believe that Citrus sinesis - Sweet lime Battayi is not even mentioned as a cure for diabetes in the standard text books of Indian Medicine.

Diabetologists, nutritionists and dietitians of our state have met under the auspices of the Andhra Pradesh Diabetes Federation on December 12, 1992 at the Nizam's Institute of Medical Sciences and condemned this unauthentic statement over mass media and expressed serious concern over such continued and ill founded announcements in public. It has also been unanimously decided that such spurious claims in the press and T.V. should no longer be ignored as before, and the truth in such claims should be made known to the gullible diabetics more vigorously.

Diabetics tend to believe that there is a cure for diabetes in other systems of medicine, and they also believe that either the allopathics are not aware of those medicines or they are willfully suppressing the facts. First of all I would like to elaborate on this - there is no cure yet for diabetes in any system of medicine anywhere in the world, which is partly because diabetes is not a single disease like malaria, typhoid or tuberculosis. So, there can not be any claim on any drug at some dose curing diabetes in some days. Diabetes is only a cluster of symptoms like in an aging process which manifests as graying of hair or wrinkling of skin. As with aging symptoms, diabetes may occur at a very early age in a few, and at some time of the life in most.

Believing that a single plant or mineral medicine can cure or atleast reduce the blood glucose in all diabetics can not be true. And such are the unsubstantiated claims and contentions by the physicians practicing alternate systems of medicine. Diabetes manifests in different persons in many different ways, and depending on the age, severity of the symptoms and involvement of other organs in the body, medical treatment greatly varies. For example a diabetic, either in young age, during pregnancy, if suffering from tuberculosis or a foot ulcer or, with recent heart attack or paralysis, should be given insulin injections only, and not other antidiabetic drugs of any systems of medicine, not even oral drugs usually prescribed by allopathics.

Further, diabetic symptoms within an individual vary greatly from time to time depending on the type of treatment and other factors. Occassionally, one may even come across a diabetic with very high blood glucose to start with, and after taking insulin injections for some time becoming `normal' without the need for further insulin. This is popularly called a `honey moon phase' in a diabetic which may last for few weeks to few years. Some of the claims on cure in diabetes by indigenous drugs can be attributed to this phase.

There is an objective test to prove or to disprove claims on any substance with blood glucose lowering effect. In a person with fasting and early morning blood glucose exceeding 250 mg/dl, a non-toxic dose of a test substance should be able to bring down the blood glucose level by atleast 30 percent at the end of four hours. All the known indigenous drugs for diabetes do tend to lower blood glucose only when the morning blood glucose in a person is less than 250 mg/dl only, and so they may be some use in mild diabetics along with dietary and activity management.

One should also consider diabetes as a complex situation of many symptoms and not just as a rise in blood glucose alone. Unfortunately all diabetics are made to put lot of emphasis on reducing blood glucose by whatever means they are familiar with, either by diet or ayurvedic drugs. High blood glucose is only a small part of the diabetic problem. Maintaining ideal body weight, identifying and treating high fat levels in the blood, treating high blood pressure, and avoidance of other risk factors like smoking and sedentary life style, are as important as treating high blood sugar levels of a diabetic. That is the reason for diabetics developing problems with heart, kidney, eyes or legs in spite of achieving good blood glucose control with indigenous drugs over many years.

Ayurvedic literature refers to usefulness of plant extracts in diabetes mellitus, while pharmacological studies in the last five decades have not borne out adequate effectiveness of such blood glucose lowering drugs. Extracts of leaves, flowers, fruits, seeds, wood, bark, roots or whole plant of more than a hundred Indian medicinal plants are in common use for diabetes treatment by Ayurvedic, Unani and Siddha Physicians in India.

Researchers of the Indian Council of Medical Research and the National Institute of Nutrition at Hyderabad, Council for Scientific and Industrial Research and the Central Drug Research Institute at Lucknow, and Biochemistry and Pharmacology departments of many Medical Colleges all over the country are actively involved in studying the active principles of all these plant medicines used in diabetes. Apart from the public institutions, many private sector organizations within India as well as large international pharmaceutical industries abroad, are spending millions of rupees in an effort to identify and market newer drugs for diabetes from among the galaxy of indian medicines in practice.

Central Drug Research Institute of Lucknow, has from time to time published data on scope of indigenous drugs in the treatment of diabetes. Literature from other countries especially Middle-East, wherein practice of indigenous drugs is as well followed is also available showing that certain plants, leaves, roots, bulbs, seeds, fruits and flower are indeed effective hypoglycemic agents. Napralert (Natural Product Alert) at the College of Pharmacy, University of Illinois in Chicago has now well established computerized data on all plant products with favorable effect on blood glucose effect. World Health Organization has of recent highly appreciated the pioneering efforts by the Indian researchers in alternate medicines for diabetes, and encouraged similar research in traditional medicine in the developing countries.

Some of the well known Indian medicinal plants in use for diabetes treatment are, Adhathoda vasica - Saraswathi aaku, Allium Sativa - Vellulli, Allium cepa - Ulli, Azadirachta indica - Vepa, Bambusa arundinacea - Veduru, Bauhinia purpurea - Kanchanam, Cannabis Indica - Ganjayi, Coccinia cordifolia - Donda, Cuminum cyminum - Jeelakarra, Curcuma longa - Pasupu, Cyamopsis tetragonolobus -Goru chikkudu, Dolichos biflorus - Ulavalu, Dolichos lablab - Chikkudu, Emblica officinalis - Usiri, Ficus bengalensis - Marri, Glycine max - Soya, Gymnema Sylvestre - Gurmar, Mimordica charantia - Kakara, Murraya koenigii - Karivepaku, Musa paradisiaca - Arati, Nymphaea nouchali - Tella kaluva, Phaseolus vulgaris - Rajmah, Phyllanthus distichus - Racha usiri, Prunus persica - Beri kai, Psidium guajava - Jama, Pterocarpus marsupium - Vijaysar, Salacia prenoides - Saptarangi, Syzygium cumini - Neredu, Tricosanthes diocia - Kommu potla, Trigonella foenum graecum - Menthulu. Some edible mushrooms - Kukka godugu, and certain algae exudation from Himalayan rocks - Shilajeet are also popular among the Indian medicines for diabetes.

In view of lack of authentic data on the clinical efficacy of reputed plant drugs, after a careful literature survey and discussions with Ayurvedic Physicians, the Indian Council of Medical Research has selected two single plant products Vijaysar and Neredu, and Nishamalak - a compound preparation of Usiri and Pasupu, for clinical trials in diabetes patients at St. John's Medical College, All India Institute of Medical Sciences, Madras Medical College and Seth G.S. Medical College, Bombay since 1987. Preliminary reports of these studies are not very encouraging, though the trials are continuing.

So far gum guar from Indian cluster beans - Goru chikkudu, is the only plant product that has reached the stage of being marketed after extensive animal studies and large scale clinical trials in our country as well as other countries. The proven blood glucose lowering effect of gum guar, is however due to its high fiber content and not due to any chemical principle stimulating insulin release in human body.

The seeds and leaves of fenugreek, a condiment known to us as Menthulu was mentioned in Ayurvedic literature, Greek and Latin Pharmacopeas also. Scientists at the National Institute of Nutrition in Hyderabad studied the gum in the seeds which is not destroyed during cooking, and advised consumption of debitterized seeds of Menthulu, adding them to chapathi flour or dal, or taking the seeds before meals as a supplement to diabetic management and of course, not as a substitution therapy.

In a recent well attended diabetic camp at Toopran of Medak district, chilli powder along with cooked rice was prescribed as the treatment for thousands of diabetics, though these claims were not substantiated later by either a cure or atleast a fall in blood glucose. In my literature review, I have not yet come across any mention of the beneficial effects of chillis in diabetes. Interestingly, capsaicin a plant alkaloid available in various species of Capsicum - Mirchi, is marketed for the last three years in the United States as the specific treatment for the burning pains of the diabetic neuropathy. However, this chilli alkaloid is not reported as effective for blood glucose control in diabetics.

Lastly, I would like to make certain humble suggestions to my specialist colleagues of indigenous systems of medicine - please do not try to convince diabetics that there is a permanent cure for diabetes in traditional systems. Do not use arsenic, gold or silver and such harmful minerals and chemicals in treating diabetes. Atleast those diabetics with heart, kidney and eye problems, skin infections, ulcers or tuberculosis, should be immediately referred to a allopathy physician immediately. They should not attempt to treat diabetes in children, pregnant women and immediately before or after any surgery. An ideal diabetic for treatment by traditional medicine would be middle aged between 40 and 60 years of age, obese, recently diagnosed as diabetic during the first year, with morning fasting blood glucose never exceeding 250 mg/dl, and without any complications involving heart, brain, kidney, eyes and legs. There is no doubt that there has been wealth of indigenous drugs for effective treatment of many diseases, including diabetes, however the contribution of the scientists in this field of in the present era have not been substantial.

updated on March 18, 2002